Does oral methylprednisolone work as well as Solu-medrol to treat MS relapses?

I imagine that almost all of us that have relapsing-remitting MS have been treated with Solu-medrol (intravenous methylprednisolone). I also imagine that many of us who were treated with Solu-medrol have a horror story, or at least a complaint, about this treatment.

Yes, the effects can be almost miraculous – I have dragged myself into the clinic blind in one eye and after a one-hour infusion, I have stood up and briskly walked out with full vision. Of course, I also tasted metal and felt like I had swallowed acid, after pouring some of it on my face. I have described treatment with Solu-medrol as being like someone offering to remove a bear trap from my leg, while knowing that they are going to punch me in the face as soon as it is removed.

However, the first thought I have when I hear that I need a course of Solu-medrol is that I don’t really want to have an infusion. It may sound silly (especially from someone who injects themselves daily), but I still have anxiety about the needle being stuck into my hand. I also tend to focus on the catheter that is stuck in my hand during the whole infusion process, which starts to become extremely creepy after a couple of minutes.

Therefore, I was pretty interested to attend the session called Efficacy and safety of oral versus intravenous (IV) high-dose methylprednisolone in multiple sclerosis relapses, a randomized double blind trial (COPOUSEP) at the 2014 Joint ACTRIMS-ECTRIMS Meeting.

This trial is a “non-inferiority trial” comparing oral methylprednisolone (Prednisone) to Solu-medrol, by giving 200 patients having a relapse either 1000 mg or Prednisone or Solu-medrol for 3 days. The researchers then monitored patients to see how many patients were “improved” at 28 days after treatment, as well as looking at other factors. So that participants were not aware which treatment they were receiving, the study was a “double-dummy” design, meaning all participants were given both an infusion and capsules, one of which was a placebo.

Bottom line, there was no difference between the two treatments. Both were found to have about the same effectiveness on the following measures:

  • “Improved” at 28 days after treatment (77.7% IV, 77.9% oral)
  • 16% of patients on IV methylprednisolone needed retreatment versus 12.6% on oral treatment
  • 43% on IV treatment totally recovered versus 39% on oral treatment
  • 27.6% of people on IV treatment had another relapse after a median time of 86 days, versus 32% on oral treatment having another relapse after a median of 90.5 days

The two treatments also had very similar rates of side effects, primarily: metallic tastes, hot flashes, headache, insomnia and agitation. The last two were experienced by slightly more people in the oral treatment group.

Bottom line: I’m taking the results of this study as pretty good news, as I’m guessing that I’m not the only one who doesn’t love the infusion process. I also found it interesting that the protocol was only 3 days, which is more common in Europe, where the study was conducted, instead of the 5-day course that is typical in the United States. As the 5-day course of Solu-medrol is the oldest and most established treatment of anything MS-related in the US, it will be fascinating to see when or if this protocol is accepted by neurologists in this country.


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Tags Research, Treatment      1 Appreciate this
Julie

Julie Stachowiak, PhD

Julie is the author of the Multiple Sclerosis Manifesto, the winner of the 2009 ForeWord Book of the Year Award in the Health Category. She is an epidemiologist who is also a person living with MS, Julie has an in-depth understanding about current research and scientific developments around MS. She also has first-hand knowledge of the frustrations and anxiety surrounding the disease, as she had MS for at least 15 years before receiving a diagnosis in 2003 and has had several relapses since her diagnosis.